Peripheral neuropathy is a condition that results from damage to the peripheral nervous system—the network of nerves that exists outside the brain and spinal cord. These nerves play a vital role in sending sensory, motor, and autonomic signals between the central nervous system and the rest of the body. When they become damaged, the result can be pain, numbness, muscle weakness, and dysfunction in various organs.

According to research, peripheral neuropathy affects approximately 2% of the population, but the risk increases significantly with age, especially in individuals over 55. Diabetes is the most common cause, but other factors including autoimmune conditions, infections, injuries, and nutrient deficiencies may also contribute.

Types of Peripheral Neuropathy

Peripheral neuropathy isn’t a single disorder—it’s an umbrella term for a variety of nerve dysfunctions. These can be categorized in several ways based on the type of nerves involved, the pattern of symptoms, the number of affected nerves, and whether the condition is acute or chronic.

By Nerve Type:

  • Sensory nerves: Carry sensations like pain, heat, and touch to the brain.

  • Motor nerves: Transmit signals from the brain to the muscles to facilitate movement.

  • Autonomic nerves: Regulate involuntary functions such as heartbeat, digestion, and breathing.

Most peripheral neuropathies affect both sensory and motor nerves, but some may affect one more than the other. Autonomic neuropathies are less common but can be severe.

By Nerve Fiber Size:

  • Large fibers transmit motor signals and detect position, touch, and vibration.

  • Small fibers carry pain and temperature signals and include autonomic fibers.

Length-Dependent vs. Non-Length-Dependent Neuropathy:

  • Length-dependent neuropathy begins in the longest nerves first—typically affecting the toes and feet before progressing upward.

  • Non-length-dependent neuropathy, such as chronic inflammatory demyelinating polyneuropathy (CIDP), may affect more proximal areas like the arms and torso.

Mononeuropathy vs. Polyneuropathy:

  • Mononeuropathy affects a single nerve (e.g., carpal tunnel syndrome or ulnar neuropathy).

  • Polyneuropathy impacts multiple nerves across various areas of the body.

Acute vs. Chronic:

  • Acute neuropathy has a sudden onset and progresses quickly, often due to inflammation or immune response (e.g., Guillain-Barré syndrome).

  • Chronic neuropathy develops slowly and may be caused by conditions like diabetes or long-term alcohol abuse.

Common Symptoms

The symptoms of peripheral neuropathy can vary greatly depending on which nerves are affected and how severely. However, the condition most often presents with a chronic, length-dependent pattern and primarily affects sensory nerves.

Typical sensory symptoms include:

  • Tingling, prickling, or “pins and needles” sensations

  • Burning or stabbing pain

  • Numbness or loss of feeling

  • Increased sensitivity to touch

  • Inability to perceive temperature or vibration

Motor symptoms may include:

  • Muscle weakness

  • Difficulty with coordination and balance

  • Cramping or twitching

  • Muscle wasting (atrophy)

Autonomic symptoms can include:

  • Dizziness or fainting due to blood pressure drops

  • Digestive issues like bloating or constipation

  • Excessive or reduced sweating

  • Bladder dysfunction

  • Sexual problems

Examples of Symptom Patterns

Diabetic Neuropathy

Diabetic peripheral neuropathy is the most common type and typically affects both feet first. Symptoms then progress to the calves and, eventually, the hands once the nerves above the knees are affected. Many patients don’t experience pain but may have significantly reduced sensation, increasing the risk of unnoticed injuries and infections. This can lead to serious complications, including amputation.

Charcot-Marie-Tooth Disease

This is the most common inherited cause of peripheral neuropathy. It predominantly affects motor nerves, leading to weakness in the lower legs and feet, foot deformities, difficulty walking, and loss of balance. Sensory symptoms are typically mild or absent.

What Causes Peripheral Neuropathy?

There are dozens of potential causes for peripheral neuropathy. Identifying the root issue is crucial to effective treatment and prognosis.

The most common causes include:

  • Diabetes: High blood sugar damages nerves and blood vessels, especially over time.

  • Alcohol abuse: Chronic consumption can lead to nerve damage and nutritional deficiencies.

  • Infections: Such as HIV, Lyme disease, hepatitis C, and leprosy.

  • Autoimmune disorders: Including lupus, rheumatoid arthritis, and Sjögren's syndrome.

  • Nutritional deficiencies: Especially B12, B6, and vitamin E.

  • Medications: Especially chemotherapy and certain antibiotics.

  • Toxins: Heavy metals and industrial chemicals.

  • Inherited conditions: Such as Charcot-Marie-Tooth disease.

  • Kidney and liver disease: Can result in the accumulation of toxins affecting nerve function.

  • Tumors and cancers: Certain malignancies can produce harmful antibodies.

In roughly 25% of cases, no clear cause is identified—these are termed “idiopathic peripheral neuropathies.”

Diagnosing Peripheral Neuropathy

A proper diagnosis involves a detailed medical history, physical examination, and targeted diagnostic testing. Physicians look for:

  • Muscle weakness or wasting

  • Loss of sensation or altered perception

  • Absent or reduced reflexes

  • Skin changes and ulcers (especially in diabetic patients)

Common diagnostic tests include:

  • Blood tests: Check for diabetes, vitamin deficiencies, kidney/liver function, and autoimmune markers.

  • Electromyography (EMG): Measures muscle response to nerve stimulation.

  • Nerve conduction studies (NCS): Assess how well electrical signals travel along your nerves.

  • Imaging (MRI or CT): Useful if nerve compression or structural issues are suspected.

  • Genetic testing: May be necessary for inherited forms.

  • Skin or nerve biopsy: Used in rare, complex cases to assess damage at the tissue level.

Treatment Options

Peripheral neuropathy treatment hinges on addressing the underlying cause. When this is possible—such as correcting a vitamin deficiency or managing diabetes—symptoms may improve or stabilize. In cases where the damage is irreversible, symptom management becomes the goal.

Medications for nerve pain include:

  • Gabapentin (Neurontin)

  • Duloxetine (Cymbalta)

  • Amitriptyline (Elavil)

  • Venlafaxine (Effexor)

  • Topical treatments: Lidocaine patches or capsaicin cream

Other interventions:

  • Physical therapy: To maintain strength and mobility

  • Assistive devices: Braces or orthopedic shoes

  • Occupational therapy: To help adapt to physical limitations

  • Immunosuppressive treatments: For inflammatory neuropathies like CIDP (e.g., corticosteroids, IVIG, rituximab)

Lifestyle modifications:

  • Reducing alcohol intake

  • Quitting smoking

  • Eating a nutrient-rich diet

  • Exercising regularly (under supervision)

Preventive Measures

While not all types of peripheral neuropathy are preventable, proactive steps can help reduce your risk.

Tips for prevention:

  • Manage blood sugar levels carefully if you have diabetes

  • Avoid alcohol or use it only in moderation

  • Protect yourself from toxins in occupational or home settings

  • Take supplements if you’re at risk for vitamin deficiencies

  • Monitor medications that may affect nerve function

  • Exercise regularly to promote circulation and nerve health

Related Health Conditions

People with peripheral neuropathy often face other medical challenges. For example, those with diabetic neuropathy may also experience:

  • Retinopathy: Damage to blood vessels in the eyes

  • Nephropathy: Declining kidney function

  • Cardiovascular disease

The combination of these conditions can increase disability and decrease quality of life if not properly managed.

Living With Peripheral Neuropathy

For most individuals, peripheral neuropathy is manageable with a tailored treatment plan. Early diagnosis and treatment greatly improve outcomes. People with diabetes can significantly reduce their risk of complications through proper blood sugar control, routine foot checks, and consistent medical care.

Self-care recommendations:

  • Inspect your feet daily for injuries or infections

  • Wear proper footwear to prevent trauma

  • Follow up regularly with your healthcare provider

  • Stay active and engage in gentle exercise

While peripheral neuropathy can affect day-to-day living, many people go on to live full, independent lives with the right care and support.